French results with Ablatherm HIFU

Replicant · Moderator Joined: 01 Nov 2006 Posts: 744

Oncologic control provided by HIFU therapy as single treatment in men with clinically localized prostate cancer.
Misraï V, Rouprêt M, Chartier-Kastler E, Comperat E, Renard-Penna R, Haertig A, Bitker MO, Richard F, Conort P.
World J Urol. 2008 Oct;26(5):481-5. Epub 2008 Jun 26.
PMID: 18581118
http://tinyurl.com/mxdubf

OBJECTIVE: To assess the long term oncologic results of high-intensity focused ultrasound therapy (HIFU) as a primary and single treatment for clinically localized prostate cancer. METHODS: A total of 119 patients with clinically localized prostate cancer underwent HIFU (Ablatherm((R)), EDAP, France) as first-line treatment and were retrospectively reviewed. They were stratified according to risk groups proposed by D'Amico. No patient had undergone previous hormonal therapy. PSA level was monitored at 3, 6, 12, 18, 24 months and then yearly. According to the latest ASTRO criteria, failure was defined by a PSA rise of 2 ng/ml or more above the PSA nadir. The biochemical-free survival rate (BFSR) was calculated. RESULTS: Mean patient age was 68 +/- 7.8 years (46-83). Mean follow-up was 3.9 years (1-6.8 ). Overall 52 patients (43.7%) experienced a biochemical recurrence which included 26, 23 and 3 patients in the low, intermediate and high-risk groups, respectively. In univariate and multivariate analyses, there was a statistical association between preoperative PSA value > 10, a nadir PSA value > 1 and the risk of biochemical recurrence (P < 0.05). The 5-year BFSR rate was 30% with no statistical difference between low- and intermediate-risk patients. None of the 119 patients died of prostate cancer. CONCLUSION: High-intensity focused ultrasound therapy provides efficient oncologic control only in patients with low-risk prostate cancer. However, our data could be used to improve the selection of patients who are potential candidates for HIFU therapy.
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Replicant

Dx Feb 2006, PSA 9 @age 43
RRP Apr 2006 - Gleason 3+4, T2c, NXMX, pos margins
PSA 5/06 <0.1, 8/06 0.2, 12/06 0.6, 1/07 0.7.
Salvage radiation (IMRT) total dose 70.2 Gy, Jan-Mar 2007@ age 44
PSA 6/07 0.1, 9/07 (and thereafter) <0.1
http://pcabefore50.blogspot.com

Replicant · Moderator Joined: 01 Nov 2006 Posts: 744

This time, HIFU in salvage after external beam radiation:

[Locally recurrent prostatic adenocarcinoma after exclusive radiotherapy: results of high intensity focused ultrasound]
Poissonnier L, Murat FJ, Belot A, Bouvier R, Rabilloud M, Rouviere O, Chapelon JY, Gelet A.
Prog Urol. 2008 Apr;18(4):223-9. Epub 2008 May 2. French.
PMID: 18501302
http://tinyurl.com/mv5pgo

Service d'urologie et chirurgie de la transplantation, hospices civils de Lyon, hôpital Edouard-Herriot, université Claude-Bernard de Lyon-1, 5, place d'Arsonval, Lyon 69003, France.

OBJECTIVES: To determine the efficacy and adverse effects of high intensity focused ultrasound (HIFU) for the treatment of local recurrence of prostate cancer after exclusive external beam radiotherapy. MATERIAL AND METHODS: Seventy-two patients with histologically and biologically documented local recurrence after radiotherapy were treated by HIFU. The mean age was 68.27+/-5.93 years, and mean PSA was 6.64+/-7.26ng/ml. Thirty patients were treated according to standard parameters and 42 according to specific parameters. ASTRO 2005 criteria, specific for salvage therapy (Phoenix consensus), were used to define recurrence. Progression-free survival was calculated by the Kaplan-Meier method. RESULTS: Mean follow-up was 39+/-28 months. The negative biopsy rate was 80% and the median nadir PSA was 0.10ng/ml. Specific survival was 94% at three years and 90% at five years, and progression-free survival was 50% at three years and 44% at five years. The urinary incontinence rate was 44% (grade 1 : 12%, grade 2/3 : 32%) and the urethral stricture or bladder neck stenosis rate was 30%. The use of specific parameters reduced the incidence of severe incontinence (19% versus 50, P=0.005) and stenosis (24% versus 40). CONCLUSIONS: Treatment with HIFU achieved a five-year progression-free survival of 44%, but patients must be clearly informed about the high rate of adverse effects.
_________________
Replicant

Dx Feb 2006, PSA 9 @age 43
RRP Apr 2006 - Gleason 3+4, T2c, NXMX, pos margins
PSA 5/06 <0.1, 8/06 0.2, 12/06 0.6, 1/07 0.7.
Salvage radiation (IMRT) total dose 70.2 Gy, Jan-Mar 2007@ age 44
PSA 6/07 0.1, 9/07 (and thereafter) <0.1
http://pcabefore50.blogspot.com

Replicant · Moderator Joined: 01 Nov 2006 Posts: 744

http://tinyurl.com/l9xaro

A literature review

High-intensity focused ultrasound in prostate cancer; a systematic literature review of the French Association of Urology.
Rebillard X, Soulié M, Chartier-Kastler E, Davin JL, Mignard JP, Moreau JL, Coulange C; Association Francaise d'Urologie.
BJU Int. 2008 May;101(10):1205-13. Epub 2008 Mar 4. Review.
PMID: 18325057

Clinique Beau Soleil, Montpellier, France.

We discuss the efficacy and safety of high-intensity focused ultrasound (HIFU) in patients with prostate cancer, to define the best indications for HIFU in daily clinical practice as primary therapy. We searched Medline and Embase for clinical studies evaluating the efficacy and safety of HIFU in prostate cancer (July 2007), and abstracts presented at the 2005-2007 annual meetings of the European Association of Urology and American Urological Association were screened. In all, 37 articles/abstracts were selected. As the data on HIFU as salvage therapy were limited, we focused on HIFU as primary therapy. Studies consisted of case series only. Included patients were approximately 70 years old with T1-T2 N0M0 disease, Gleason Score <or=7, a prostate-specific antigen (PSA) level of <or=28 ng/mL and a prostate volume of <or=40 mL. Negative biopsy rates with the Ablatherm device (EDAP TMS S.A., Vaulx-en-Velin, France) were 64-93%, and a PSA nadir of <or>or=70 years) with T1-T2 N0M0 disease, a Gleason score of <7, a PSA level of <15 ng/mL and a prostate volume of <40 mL. In these patients HIFU achieves short-term cancer control, as shown by a high percentage of negative biopsies and significantly reduced PSA levels.The median-term survival data also seem promising, but long-term follow-up studies are needed to further evaluate cancer-specific and overall survival rates before the indications for primary therapy can be expanded.
_________________
Replicant

Dx Feb 2006, PSA 9 @age 43
RRP Apr 2006 - Gleason 3+4, T2c, NXMX, pos margins
PSA 5/06 <0.1, 8/06 0.2, 12/06 0.6, 1/07 0.7.
Salvage radiation (IMRT) total dose 70.2 Gy, Jan-Mar 2007@ age 44
PSA 6/07 0.1, 9/07 (and thereafter) <0.1
http://pcabefore50.blogspot.com

Replicant · Moderator Joined: 01 Nov 2006 Posts: 744

What is it with the French?
http://tinyurl.com/kq4y35

Urology, Radiology and Pathology Department, Edouard Herriot Hospital, Lyon, France.

PURPOSE: To evaluate the results of high-intensity focused ultrasound (HIFU) treatment of localized prostate cancer with reference to disease-related prognostic factors. MATERIALS AND METHODS: Patients with T1-2 localized prostate cancers, prostate specific antigen (PSA) <or=15 ng/ml, Gleason score <or=7, prostate volume <or>1 ng/ml with three consecutive rises. RESULTS: The study included 227 patients. Mean follow-up was 27+/-20 months (12-121 months). Eighty-six percent had negative control biopsies. Median nadir PSA was 0.10 ng/ml. The actuarial 5-year disease-free survival rate (DFSR), combining pathologic and biochemical outcomes, was 66%. DFSR showed a significant decrease when stratified according to initial PSA level: 90% with PSA <or=4 ng/ml versus 57% and 61% with PSA between 4.1 and 10, and between 10.1 and 15 ng/ml, respectively. Incontinence and bladder neck stricture decreased with the treatment procedure standardization from 28% and 31% to 9% and 6%, respectively. CONCLUSIONS: HIFU for localized prostate cancer offered high control of local disease with low morbidity. The ability to repeat the HIFU treatment is of major interest.
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Replicant

Dx Feb 2006, PSA 9 @age 43
RRP Apr 2006 - Gleason 3+4, T2c, NXMX, pos margins
PSA 5/06 <0.1, 8/06 0.2, 12/06 0.6, 1/07 0.7.
Salvage radiation (IMRT) total dose 70.2 Gy, Jan-Mar 2007@ age 44
PSA 6/07 0.1, 9/07 (and thereafter) <0.1
http://pcabefore50.blogspot.com

Replicant · Moderator Joined: 01 Nov 2006 Posts: 744

http://tinyurl.com/lqmlu3

High-intensity-focused ultrasound in the treatment of primary prostate cancer: the first UK series.
Ahmed HU, Zacharakis E, Dudderidge T, Armitage JN, Scott R, Calleary J, Illing R, Kirkham A, Freeman A, Ogden C, Allen C, Emberton M.
Br J Cancer. 2009 Jul 7;101(1):19-26. Epub 2009 Jun 9.
PMID: 19513068

Division of Surgery and Interventional Sciences, University College London, London, UK. hashim.ahmed@ucl.ac.uk

BACKGROUND: The use of minimally invasive ablative therapies in localised prostate cancer offer potential for a middle ground between active surveillance and radical therapy. METHODS: An analysis of men with organ-confined prostate cancer treated with transrectal whole-gland HIFU (Sonablate 500) between 1 February 2005 and 15 May 2007 was carried out in two centres. Outcome data (side-effects using validated patient questionnaires, biochemical, histology) were evaluated. RESULTS: A total of 172 men were treated under general anaesthetic as day-case procedures with 78% discharged a mean 5 h after treatment. Mean follow-up was 346 days (range 135-759 days). Urethral stricture was significantly lower in those with suprapubic catheter compared with urethral catheters (19.4 vs 40.4%, P=0.005). Antibiotics were given to 23.8% of patients for presumed urinary tract infection and the rate of epididymitis was 7.6%. Potency was maintained in 70% by 12 months, whereas mild stress urinary incontinence (no pads) was reported in 7.0% (12 out of 172) with a further 0.6% (1 out of 172) requiring pads. There was no rectal toxicity and no recto-urethral fistulae. In all, 78.3% achieved a PSA nadir < or =0.5 microg ml(-1) at 12 months, with 57.8% achieving < or =0.2 microg ml(-1). Then, 8 out of 13 were retreated with HIFU, one had salvage external beam radiotherapy and four chose active surveillance for small-volume low-risk disease. Overall, there was no evidence of disease (PSA <0.5 microg ml(-1) or negative biopsy if nadir not achieved) after one HIFU session in 92.4% (159 out of 172) of patients. CONCLUSION: HIFU is a minimally invasive, day-case ablative technique that can achieve good biochemical outcomes in the short term with minimal urinary incontinence and acceptable levels of erectile dysfunction. Long-term outcome needs further evaluation and the inception of an international registry for cases treated using HIFU will significantly aid this health technology assessment.

PMID: 19513068
_________________
Replicant

Dx Feb 2006, PSA 9 @age 43
RRP Apr 2006 - Gleason 3+4, T2c, NXMX, pos margins
PSA 5/06 <0.1, 8/06 0.2, 12/06 0.6, 1/07 0.7.
Salvage radiation (IMRT) total dose 70.2 Gy, Jan-Mar 2007@ age 44
PSA 6/07 0.1, 9/07 (and thereafter) <0.1
http://pcabefore50.blogspot.com

Replicant · Moderator Joined: 01 Nov 2006 Posts: 744

This one not successful.
http://tinyurl.com/l2d5qo
High-intensity focused ultrasound for localized prostate cancer: initial experience with a 2-year follow-up.
Challacombe BJ, Murphy DG, Zakri R, Cahill DJ.
BJU Int. 2009 Jul;104(2):200-4. Epub 2009 Feb 11.
PMID: 19220245

The Urology Centre, Guy's and St Thomas' NHS Foundation Trust, London, UK. benchallacombe@doctors.org.uk

OBJECTIVE: To report on the short-term functional and oncological results, from one institution, of high-intensity focused ultrasound (HIFU) for treating localized prostate cancer. PATIENTS AND METHODS: Over a 3-year period, 43 patients with localized prostate cancer were scheduled for HIFU in the primary (31) and salvage (12) settings using a second-generation Ablatherm device (EDAP, Lyon, France). Oncological failure was defined by several criteria, including biochemical failure (assessed using both the Phoenix definition of the nadir + 2 ng/mL) and the current Food and Drug Administration (FDA) trial endpoint of a prostate-specific antigen (PSA) level of > or = 0.5 ng/mL, or starting salvage therapy, or the presence of cancer on biopsy after treatment. RESULTS: Three patients had their procedures abandoned due to technical limitations/rectal wall thickness. The mean PSA levels in the primary and salvage groups were 9.2 and 5.1 ng/mL, respectively. The mean HIFU treatment time in the primary and salvage groups was 71.1 and 63.3 min, respectively. Using the Phoenix definition of biochemical failure, HIFU treatment failed in 13 patients in the primary group (46%) and five in the salvage group. Using the FDA trial endpoint, HIFU failed in 21 patients in the primary group (75%) and eight in the salvage group. One man died from metastatic prostate cancer 18 months after salvage HIFU. There were two urethral strictures in the primary (7%) and one in the salvage treatment group. There were two prostato-rectal fistulae in the salvage HIFU group. CONCLUSIONS: HIFU is proposed to be a minimally invasive low-morbidity ablative treatment for localized prostate cancer, and with good efficacy. The present limited series is unable to support these claims. There were significant rates of complications and oncological failure in both the primary and salvage setting. As a result we have suspended our programme pending further evidence of its safety and efficacy.
PMID: 19220245
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Replicant

Dx Feb 2006, PSA 9 @age 43
RRP Apr 2006 - Gleason 3+4, T2c, NXMX, pos margins
PSA 5/06 <0.1, 8/06 0.2, 12/06 0.6, 1/07 0.7.
Salvage radiation (IMRT) total dose 70.2 Gy, Jan-Mar 2007@ age 44
PSA 6/07 0.1, 9/07 (and thereafter) <0.1
http://pcabefore50.blogspot.com

Replicant · Moderator Joined: 01 Nov 2006 Posts: 744

http://tinyurl.com/l97s2o

Eight years' experience with high-intensity focused ultrasonography for treatment of localized prostate cancer.
Blana A, Rogenhofer S, Ganzer R, Lunz JC, Schostak M, Wieland WF, Walter B.
Urology. 2008 Dec;72(6):1329-33; discussion 1333-4. Epub 2008 Oct 1.
PMID: 18829078

Department of Urology, University of Regensburg, St Josef's Hospital, Regensburg, Germany. blana@web.de

OBJECTIVES: To report on the long-term results of high-intensity focused ultrasonography (HIFU) in the treatment of localized prostate cancer. METHODS: Patients with clinical Stage T1-T2N0M0, biopsy-proven, localized prostate cancer, with a serum prostate-specific antigen (PSA) level of <or=20 ng/mL, Gleason score of <or=7, and with no previous curative prostate cancer treatment, were included. All patients underwent HIFU using the Ablatherm device and were required to have a minimal follow-up of 3 years after the last HIFU session to be included in this analysis. Follow-up included PSA measurement and biopsy performed 3-6 months after treatment and in conjunction with an increasing PSA level. Biochemical failure was defined according to the Phoenix definition (PSA nadir + 2 ng/mL). In determining the disease-free survival rate, treatment was considered to have failed if any of the following occurred: biochemical failure, positive biopsy findings, or the initiation of salvage treatment. RESULTS: The study included 163 patients. Within the 4.8 +/- 1.2 years of follow-up, no patient died of prostate cancer. Of the 163 patients, 86.4% achieved a PSA nadir of <1 ng/mL and 92.7% had negative post-treatment biopsy findings. The actuarial biochemical survival rate at 5 years was 75%. The actuarial disease-free survival rate at 5 years was 66%, with salvage treatment initiated for 12% of the patients. On multivariate analysis, the pretreatment PSA level was the only statistically significant predictive factor of recurrence (P = .005). CONCLUSIONS: The results after long-term follow-up have indicated that HIFU is an efficient and safe treatment for patients with localized prostate cancer.
_________________
Replicant

Dx Feb 2006, PSA 9 @age 43
RRP Apr 2006 - Gleason 3+4, T2c, NXMX, pos margins
PSA 5/06 <0.1, 8/06 0.2, 12/06 0.6, 1/07 0.7.
Salvage radiation (IMRT) total dose 70.2 Gy, Jan-Mar 2007@ age 44
PSA 6/07 0.1, 9/07 (and thereafter) <0.1
http://pcabefore50.blogspot.com

Replicant · Moderator Joined: 01 Nov 2006 Posts: 744

http://tinyurl.com/ndb4fp

[Treatment of prostatic cancer with high intensity focused ultrasound (HIFU) using Ablatherm device]
Aliaev IuG, Krupinov GE, Bezrukov EA, Grigorian VA, Amosov AV, Chalyĭ ME, Kobzev DN, Bruk IuF, Shestiperov PA.
Urologiia. 2007 Nov-Dec;(6):39-44. Russian.
PMID: 18649659

High intensity focused ultrasound (HIFU) is a method of delivering acoustic energy to a focal point and thus destroying it, causing coagulation necrosis. Repeating the fires, the whole needed volume of organ can be treated without damaging the surrounding tissue. A total of 122 patients with biopsy-proven prostatic cancer (and 2 more patients had only high-grade PIN) have been treated in our clinic for 3.5 years using the Ablatherm device. Seventy one of them entered this study. They were followed up for six months to three years at a regular interval. Follow-up PSA measurements and control sextant biopsies were made. The median PSA nadir 1.5-3.0 months after treatment ranged from 0.10 ng/ml (in low-risk localized prostate cancer group) to 2.50 ng/ml (in patients with disseminated process). Negative control biopsies were registered in 74-77.7% patients with local prostatic cancer and in 60-68% patients with disseminated process. Of all the patients, 90% had undergone transurethral resection of the prostate before HIFU treatment. Such combination improved the efficacy of HIFU and significantly reduced treatment-related morbidity. Urinary stress incontinence grade 2 was observed in 1.6% and grade 3--in 0.8% of all the patients. No other severe complications occurred. The erectile function was preserved in 71.2% patients. Our results demonstrate efficacy and safety of HIFU. HIFU does not exclude other treatment options and can be repeated. HIFU seems to be a valid alternative treatment for patients with contraindications for radical surgery.
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Replicant

Dx Feb 2006, PSA 9 @age 43
RRP Apr 2006 - Gleason 3+4, T2c, NXMX, pos margins
PSA 5/06 <0.1, 8/06 0.2, 12/06 0.6, 1/07 0.7.
Salvage radiation (IMRT) total dose 70.2 Gy, Jan-Mar 2007@ age 44
PSA 6/07 0.1, 9/07 (and thereafter) <0.1
http://pcabefore50.blogspot.com

Replicant · Moderator Joined: 01 Nov 2006 Posts: 744

http://tinyurl.com/klyy3d
High Intensity Focused Ultrasound (HIFU): a useful alternative choice in prostate cancer treatment. Preliminary results.
Maestroni U, Ziveri M, Azzolini N, Dinale F, Ziglioli F, Campaniello G, Frattini A, Ferretti S.
Acta Biomed. 2008 Dec;79(3):211-6.
PMID: 19260381

Unit of Urology, Surgical Departement, University Hospital of Parma, Parma, Italy. umaestroni@ao.pr.it

INTRODUCTION AND AIMS: High-Intensity Focused Ultrasound (HIFU) represents an alternative choice in mini-invasive treatment of prostate cancer. The technology of the device used to perform the treatment allows to exactly destroy a pre-selected area and to save all the tissues around it. We report our experience on the effectiveness and complications of this tecnique. MATERIALS AND METHODS: From May 2006 to April 2007, 25 patients with prostate cancer were treated through Ablatherm (EDAP France) in spinal anesthesia. In the first six patients HIFU and TUR-P (Trans-Urethral Resection of Prostate) were performed in the same session and a suprapubic catheter was placed. In the other 14 patients HIFU was afterwards performed. In these patients a trans-urethral catheter was placed. All patients were divided into three groups: low risk (17 patients), intermediate risk (6 patients) and high risk (2 patients). The follow-up consisted in PSA evaluation after 1, 3, 6, 9, 12 months and in transrectal biopsy after six months. Complications related to the treatment, and symptomatological and sexual life tests were evaluated before and after the treatment. RESULTS: HIFU overall success rate was 84%(biochemical relapses in only 4 patients out of 25). Success rate was represented as follows: 94.2% in the low risk group, 83.4% in the intermediate risk group and 0% in the high risk group. No complications occurred during the treatment nor in the immediately post-operative time. CONCLUSIONS: We demonstrated that HIFU represents a useful alternative choice in mini-invasive therapy of prostate cancer. Particularly, results are remarkable in localized (low-intermediate risk) and low morbidity prostate cancer. The role of this procedure in high risk patients needs to be further evaluated. Transrectal HIFU represents a mini-invasive therapeutic option that makes the treatment of prostate cancer possible in 84% of cases. Our results agree with the literature data and demonstrate that the success of the procedure depends on the correct indication of treatment and is strictly related to progression risk parameters.

PMID: 19260381
_________________
Replicant

Dx Feb 2006, PSA 9 @age 43
RRP Apr 2006 - Gleason 3+4, T2c, NXMX, pos margins
PSA 5/06 <0.1, 8/06 0.2, 12/06 0.6, 1/07 0.7.
Salvage radiation (IMRT) total dose 70.2 Gy, Jan-Mar 2007@ age 44
PSA 6/07 0.1, 9/07 (and thereafter) <0.1
http://pcabefore50.blogspot.com

Replicant · Moderator Joined: 01 Nov 2006 Posts: 744

My conclusion remains pretty much unchanged after the above scan of literature in PubMed. Here are my thoughts. Yours, of course may differ.

HIFU looks like a valid and viable option for many men, especially at the low-risk end of the spectrum.

There have been troubling side effects in the past, but these (except in the recent UK trial) seem to be much reduced in recent years.

Prostate cancer is a slow disease, usually, which means that we won't know about long term success until a very long time has passed. But that doesn't mean a man shouldn't try HIFU if he's interested. It can be repeated if unsuccessful, and it does not rule out later non-HIFU options if necessary.

After reading and reflecting on the literature, I predict that we will see two things happen. One, based on the link notme provided to the Facebook page, is that Sonablate will pass the trial for salvage, and doctors will begin to use it "off-label" for primary disease.
Secondly, shortly thereafter, I predict that Sonablate will be approved for treatment of primary disease. The time frame? No more than 5 years for all of this, probably more like 3.

Surgery and radiation will begin to fall out of favor, as patients clamor for HIFU, as they now do for Da Vinci surgery. Non-HIFU options will not disappear, though, for a long time. And who knows what technologies are just around the corner?

Will I be proved right? I hope to come back in a few years, dig out this message, and see.
_________________
Replicant

Dx Feb 2006, PSA 9 @age 43
RRP Apr 2006 - Gleason 3+4, T2c, NXMX, pos margins
PSA 5/06 <0.1, 8/06 0.2, 12/06 0.6, 1/07 0.7.
Salvage radiation (IMRT) total dose 70.2 Gy, Jan-Mar 2007@ age 44
PSA 6/07 0.1, 9/07 (and thereafter) <0.1
http://pcabefore50.blogspot.com

notme · Guest

.
.
Just don't forget ~ clinical trials will not let an experienced doctor in ~ so the results from trials will be less than that of the experienced doctors.

The doctor in the UK trial said that the results were dismal at first in the trial and then they hit the learning curve and the results were better and better....those dismal results are still in the study....

And, I agree, "what is it with the French?" I hope I never get sick there.

You didn't repost the Japanese study, it had better results...

Replicant · Moderator Joined: 01 Nov 2006 Posts: 744

No, I didn't post the Japanese study, but it was there.

I found these others while I was looking for more follow-ups by the Japanese guy to his study from a few years ago (didn't find any).

If anyone wants to replicate the search, go to PubMed and do a search like
hifu outcome or hifu follow-up.

I just picked out the most recent ones that looked like they were about what we were interested in and skipped the ones about hifu for other diseases.

I tried to avoid bias by including all relevant citations, regardless of conclusion. I'm not sure it is possible to totally avoid bias (maybe I shouldn't bold what I thought were the interesting bits).
I invite everyone to take a look. It's really quite interesting.

http://www.ncbi.nlm.nih.gov
_________________
Replicant

Dx Feb 2006, PSA 9 @age 43
RRP Apr 2006 - Gleason 3+4, T2c, NXMX, pos margins
PSA 5/06 <0.1, 8/06 0.2, 12/06 0.6, 1/07 0.7.
Salvage radiation (IMRT) total dose 70.2 Gy, Jan-Mar 2007@ age 44
PSA 6/07 0.1, 9/07 (and thereafter) <0.1
http://pcabefore50.blogspot.com

Jean222 · Senior User Joined: 14 Dec 2008 Posts: 249

notme, with all due respect, your continual comments that trial doctors are inexperienced doctors, is, IMO, nonsense.

In the article/thread about the CBCs take on HIFU, the studies being done in London, Ontario are being done for many great reasons.

BUT one of the main reasons is that MANY experienced doctors think HIFU is good and MANY experienced doctors think there are problems with HIFU that warrant further study.

The doctors doing the studies/trials are very experienced in treating Prostate cancer.

There is NO discussion of using 'rookie' doctors at all.

I don't know where you get the idea that only inexperienced docs are doing these studies......it's just not true!

There is a REAL and VALID need to compare HIFU to other treatments and to see what the long-term outcomes are for patients.

It's only used for low risk patients.....no high risk patients are treated with HIFU in Canada.

High risk patients are offered either surgery or radiation or both.....the gold standard of care.

We all, on this forum, know how pleased you've been with your progress....may it always be so but please, be honest in your comments.

Best wishes, as always,

Jean

notme · Guest

Well!! I take offense! I am honest, and the doctors in all the studies all say they had little to no experience with HIFU when they started the study. Yes, of course, they were urologists.

Dr. Mark Emberton, who was in charge of the UK trial said: “Most of the [occurrences of retained debris or stricture] were clustered to the early part of the series at the beginning of our learning curve” and “If rates similar to those reported in this paper had persisted we would not have wanted to continue with this treatment.”
http://prostatecancerinfolink.net/2009/07/04/hifu-for-localized-prostate-cancer-a-series-of-172-uk-patients/

Dr. Scionti begged to be let into any trial, he wasn't allowed, he was told he would have a "conflict of interest", as he had an agenda--good results & approvals. He taught all the doctors in the trials in the USA, maybe that's why there aren't any bad results....so far....

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